Importance of Managing the Water-Electrolyte Balance by Delivering the Optimal Minimum Amount of Water and Sodium After Subarachnoid Hemorrhage
Importance of Managing the Water-Electrolyte Balance by Delivering the Optimal Minimum Amount of Water and Sodium After Subarachnoid Hemorrhage
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DOI：
10.1016/j.wneu.2019.05.152
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发表时间：
2019-09-01
影响因子：
2
通讯作者：
Takagi, Yasushi
中科院分区：
文献类型：
--
作者：
Shikata, Eiji;Tamura, Tetsuya;Takagi, Yasushi
背景技术背景：在蛛网膜下腔出血（aSAH）后，具有相对高钠浓度的晶体液已被用于维持脑血流。然而，通过静脉（IV）输注预防性输送水和钠不一定会改善aSAH后患者的预后，过量的水和钠供应可能会对结局产生负面影响。我们假设，分别输送最佳量的水和钠可能会改善aSAH.METHODS后的结果：我们招募了55例连续患者，他们在aSAH后接受了夹闭或血管内弹簧圈栓塞。第1组（n = 33）接受常规治疗（即，预防性IV钠和水=方案1]）。第2组（n = 22）分别给予最佳量的水和氯化钠（方案2）。结果：第1组的水和氯化钠总量中位数显著高于第2组（P < 0.01）。出院时改良兰金量表评分0-2分者，第2组15例（95%），第1组23例（55%）（P < 0.001）。多因素Logistic回归分析显示，出院后改良兰金量表评分为0-2或3-6的比值比与治疗方案（P < 0.05）和第4-8天的液体净平衡（P < 0.05）显著相关。结论：水和钠的最佳量的分开输送可能是改善aSAH预后的一种有前景的治疗策略。
BACKGROUND: After aneurysmal subarachnoid hemorrhage (aSAH), crystalloid fluids with a relatively high sodium concentration have been used to maintain the cerebral blood flow. However, the prophylactic delivery of water and sodium by intravenous (IV) infusion will not necessarily improve the prognosis of patients after aSAH, and the excessive supply of water and sodium can negatively affect the outcome. We hypothesized that the delivery of an optimal amount of water and sodium separately might improve the outcome after aSAH.METHODS: We recruited 55 consecutive patients who had undergone clipping or endovascular coil embolization after aSAH. Group 1 (n = 33) received conventional therapy (i.e., prophylactic IV sodium and water = protocol 1]). Group 2 (n = 22) received the optimal amount of water and sodium separately (protocol 2).RESULTS: The median total of water and sodium chloride supplied in group 1 was significantly greater than that supplied in group 2 (P < 0.01). The modified Rankin scale score at discharge was 0-2 in 15 patients (95%) in group 2 and 23 patients (55%) in group 1 (P < 0.001). On multivariate logistic regression analysis, the odds ratio for a discharge modified Rankin scale score of 0-2 or 3-6 was significantly associated with the treatment protocol (P < 0.05) and the net fluid balance on days 4-8 (P < 0.05).CONCLUSION: The separate delivery of optimal amounts of water and sodium could be a promising therapeutic strategy to improve the prognosis after aSAH.